HomeMy Public PortalAbout10732 LA ROSA DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL •� 1
'- DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES -
WILLIAM J. FOXY COUNTY ENGINEER I
ADDRESS
y ADDRENG
SS
FOR APPLICANT TO FILL IN LOCALITY c. gCAJ� �c-
NEAREST
ADDflE^S 10732 La Rosa St• 2EE
1-7,vc
LOCALITY Rl MDn to SERIAL NO. PERMIT NO.
CROSS ST El Monte Ave. A eyyg sj33- fey $
Ready for Inspection DATEISSUED
OWNER P. L. MCNntt
MAIL
ADDRESS QryZj San 4abriBl BlyA USEZONE OCCUPANCY BK MAP PG
CITY San GabrielTEL.No.AT 94864
CONTRACTOR L.D. & M. CONSTRUCTION CO.
CO.IMP.N0.
ADDRESS 408 Winthrop Dr.
JOB NO.
CITY Alhambra TELNGLT48315
TRUNK PERMIT NO.
REGISTRATION NO. 113613 G 42 COUNTY'
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 49 STATE ENCROACHMENT
PERMIT NO. /
BLOCK TRACT 17867 INDUSTRIAL y
WASTE APPROVAL
SIZE OF LOT NOF BL
NOW ON LOT OT
1 /CHARGES
USE OF
BUILDINGS Z R96. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE-
PUBLICSEWER @ s 3.50 RECEIPT NO. I A E— I BY
HOUSE SE W ERCONNECTING TO �C
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR - EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTEROR REPAIREXISTING /ANO- DATE IBY
SEWER OR DISPOSAL SYSTEM 1.00 moi'
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM • 1.00
CONNECTION DATA
SEPTIC TANK,SEEPA G E PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION DEPTH
CESSPOOL—ORYWELL
SPECIAL CONDITIONS ONLY 2.00 ,,.,gANHOLE 1:P7' LOWER
/T/,-YPsE OF CONNECTION LENGTH FROM
OWNERS PERMIT s 1 00 Y! CURB P.L. V WL..TO'P:L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS....................DAY OF----------- 19_-__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT........................................... BUILDING OR WORK
ADDRESS-----------_.._------_.........................._......................... SEPTIC TANK,SEEP.PIT(S)
_.._.._..__. AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-. CESSPOOL 0 DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATUR
SEEP.PIT(S)0 CESSPOOLS '
E `/�
OF PERMIT _
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